transformation trends

A Periodic Briefing


In this Issue
Transformation Is Now . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Connecticut Transforms Its System of Care Toward Recovery . . . . . . . . 2 Federal Partner Spotlight: U.S. Department of Veterans Affairs . . . . . . . 3 SAMHSA/CMHS Identifies Key Priorities . . . . . . . . . . . . . . . . . . . . . . 4 State Teams to Get Help on Mental Health Transformation . . . . . . . . . 4 Leadership Is Everyone’s Business . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
For electronic copies of Mental Health Transformation Trends, see

May/June 2005 Vol. 1, No. 2

transformation trends
A Periodic Briefing


Transformation Is Now
ransformation is happening. It is real. From California to Connecticut, promising models of transformation in behavioral health are being developed and piloted. Together with its Federal Partners, the Substance Abuse and Mental Health Services Administration (SAMHSA), is taking realistic action steps to motivate, facilitate, and compel change at the Federal, State, community, and individual levels. The Federal working group leading transformation not only fosters communication and collaboration across Federal agencies, but also encourages further alignment of Federal programs related to mental health. SAMHSA already is aligning its activities with the key priorities and the national movement to transform mental health service delivery. And it does not stop with SAMHSA. As mental health transformation unfolds across the Nation, we will continue to develop new solutions, address new issues, and mark our progress. Several initiatives are highlighted in this issue of Mental Health Transformation Trends. These include SAMHSA’s efforts around transformational leadership and the strides taken by a Federal Partner, the Veterans Health Administration. Transformation also is happening at State and local levels. In this issue, we look at the State of Connecticut, which is making great progress toward a truly recovery-oriented, consumerand family-driven mental health system. These illustrations demonstrate the synergy that results when individuals, organizations, and The President’s New Freedom governments collaborate…when they dare to Commission on Mental Health innovate…when they venture into new territories Vision Statement without being absolutely sure where their quests We envision a future when… will lead them…when they take risks in order to • everyone with a mental illness will recover, succeed. This is transformation in action! • mental illnesses can be prevented or cured, Transformation begins with a vision. But a vision can only be achieved with strong leadership. • mental illnesses are detected early, and • everyone with a mental illness at any stage We must have people like you willing to drive of life has access to effective treatment the transformation process—to be leaders who and supports—essentials for living, can blaze a trail and inspire others to follow. working, learning, and participating fully We welcome your response to the invitation to in the community. transform the mental health system!


Leadership Is Everyone’s Business
he vision of a transformed men- orientation starting in fall 2005. responsibility for promoting innovatal health system has created a As role models, transformation tion and for reinforcing individual national imperative to recognize the leaders must be capable of externalefforts toward attaining the transimportance of effective leadership izing strongly held internalized formational vision. As others are in initiating change and sustaining values and ideas that shape a unifying encouraged to individually and coleach step towards making the vision vision. These values become the lectively “own” the vision and then a reality. In response to this imperaunderpinnings of an energizing implement strategies to realize the tive, SAMHSA/CMHS is exploring changes being sought, the associated the combination of skills and abilirisks for leaders grow exponentially ties needed to promote indibecause, ultimately, leaders are vidual, organizational, and responsible for the group’s Knowledge and Individual Leader system transformation. performance. When Information Management Attributes Through collective the benefit of focus• Apply Research Findings • Agile Leadership Style efforts and partnering on the group’s • Measure Performance • Personal Values-Driven • Use Breakthrough Technologies • Visionary ships among key vision is not fully and Networking • Risk-Taking and stakeholders, embraced by • Manage Databases Courageous the demand all involved, • Resilient and Resolute for effective the potential Future Trends leaders at conflicts can in Mental Health every level undermine Transformation • Recovery Orientation Management • Science-to-Service, can be a leader’s • Organization and System Service-to-Science Transformation met. willingness Change and Learning • Evidence-Based Practices Leadership The to challenge • Collective Vision and • Disparities Elimination Competencies Transforthe status Innovation • Consumer and Familymation quo. • Strategic Alliances Relevant Outcomes • Collaborative Relationships • Privatization Leadership A leader’s • Disease Management Competensense of cies wheel purpose and Business Acumen Process “Toolkit” • Financing Strategies presented direction is • Negotiation Skills • Organizational Dynamics • Critical Thinking here is a startthe catalyst for • Human Resource Development • Dispute and Conflict ing point for a critical think• Internal/External Issues (Radar) Resolution Skills discussion about ing and strategic • Marketing and Branding • Group Facilitation Skills the many attributes alignment of events • Business-to-Business Models • Concept Mapping • Futurecasting needed. These are not and resources to man• Lateral Thinking Skills exhaustive, but suggest age necessary shifts in that formalizing leadership policy and practice. However, training and recognizing the a leader’s intuitive reactions are tremendous courage and resiliency not sufficient for effecting and leaders need will be important. environment that bolsters personal sustaining system change. How the The SAMHSA/CMHS Mental resolve and motivates others to mental health community responds Health Transformation State Incentive pursue a common goal. to the challenge of nurturing effecGrants (MHT SIGs) will provide the Balancing risk with courage will tive leadership will set the bar for initial opportunities for approaching be a hallmark of those called to lead transformation’s ultimate success. leadership from a competency-based transformation. Leaders assume




n its 2003 report, the President’s New Freedom Commission on Mental Health envisioned a future when everyone with a mental illness would recover and have access to the essentials for living, working, learning, and participating fully in the community. In Connecticut, Commissioner Thomas A. Kirk, Jr. of the Department of Mental Health and Addiction Services (DMHAS) is taking steps to help this vision become a reality. During the February 2005 meeting of the National Association of State Mental Health Program Directors Research Institute in Baltimore, Commissioner Kirk described Connecticut’s strategy: “We realized that to transform Connecticut’s behavioral health system into one that is truly recovery-oriented, we would need to make changes in many aspects of our work. This systemic approach would encompass (1) development of recovery core-values and principles, (2) establishment of a conceptual and policy framework to guide our efforts, (3) new competencies and skills for our workforce, (4) changes in programs and in the service structure to promote certain program models (such as peer-run programs and programs operated by Recovery Communities), (5) realignment of fiscal resources, and (6) review of administrative policies to ensure that recovery concepts and program models were being supported.” To start, DMHAS asked advocacy groups representing people in recovery from psychiatric and/or substance use disorders to articulate “core values” for a recovery-oriented system of care. These values were used to guide

development of a Commissioner’s Policy Statement, entitled “Promoting a Recovery-Oriented Service System” (see www.dmhas.state. This policy statement, released in September 2002, set the stage for Connecticut’s transformation and became the overarching goal for all activities at DMHAS. Next, the State defined the change strategies it would employ. These included the following: • Multi-year implementation process. • A “big tent” approach to consensus building among diverse stakeholders. • Use of “technology transfer” strategies to promote use of recoveryoriented and evidence-based practices. • Efforts to incorporate or subsume other major DMHAS programs within the recovery initiative. • A process to reorient administrative and clinical systems in support of recovery. • A non-punitive transition with service providers to recovery-oriented performance and outcome measures. Next, working with the Yale University School of Medicine, DMHAS established a Recovery Institute to train providers in recovery-oriented concepts and practices. To date, nearly 5,000 providers have received this training. DMHAS also created a competitive process through which providers applied to become a “Center of Excellence” or a “Practice Improvement Initiative” site. These sites served as incubators for emerging recovery-oriented practices. Thus far, over 50 different provider agencies are involved in these efforts. Next, service providers will be

asked to participate in a “Recovery Self-Assessment” to determine the extent to which their current practices were consistent with recovery concepts and values. DMHAS and Yale also have drafted RecoveryOriented Practice Guidelines and Standards that can help providers and people in recovery determine whether services conform to recovery concepts. The guidelines offer a roadmap for the change process. Although many significant changes have occurred, much more remains to be done. Commissioner Kirk stated, “We’ve completed the conceptual work and built consensus across the system; now we’re poised for the next, and perhaps most difficult, stage in the transformation—ensuring that clinicians are supported in carrying out the recovery-oriented practices they have learned. As we do this we must remain true to our vision— a recovery-oriented system of care that identifies and builds upon each individual’s assets, strengths, health, and competence, and that helps people to achieve a sense of mastery over their condition while regaining a meaningful, constructive sense of membership in the broader community.” To learn more about Connecticut’s recovery initiative, visit the DMHAS Web site at www.


FEDERAL PARTNER SPOTLIGHT: U.S. Department of Veterans Affairs
he U. S. Department of Veterans Affairs (VA) provides healthcare services and benefits to the Nation’s veterans. VA is the largest integrated healthcare organization in the United States and has the unique opportunity to provide a full continuum of medical, mental health, and substance abuse services. In FY 2004, VA served 5 million veterans, 28 percent of whom had a mental disorder diagnosis. Frances Murphy, M.D., M.P.H., the Veterans Health Administration’s (VHA) Deputy Under Secretary for Health for Health Policy Coordination, having served as an ex officio member of the President’s New Freedom Commission on Mental Health, now chairs VA’s Action Agenda Work Group. This group is committed to realizing the Commission’s vision and transforming VA mental health care into a consumercentered system that fully embraces the principles of recovery. On December 1, 2003, the Work Group’s Action Agenda: Achieving the Promise, Transforming Mental Health Care in VA was approved. Next, a 5year Mental Health Strategic Plan (MHSP) was developed and an Action Agenda Steering Committee was formed. The purpose of the MHSP is to drive the implementation of the Commission’s principles and goals through 265 discrete recommendations. To manage implementation of these recommendations, the Action Agenda Steering Committee has established nine Work Groups: 1. Mental Health Awareness 2. Veteran and Family Centered Care 3. Collaborative Care 4. Recovery 5. State Mental Health 6. Knowledge Management and Best Practices


7. Peer Support 8. Mental Health Research 9. Cultural Competency The overarching goal of the Action Agenda is to “orient VHA toward the expectation of recovery and the delivery of veteran-centered care and evidencebased services.” Here are some activities VA is participating in to achieve this: • A national mental health campaign to increase awareness of mental health as essential to overall health and to combat stigma. • A national strategy for suicide prevention that includes participation of families and communities. • Dissemination of collaborative care approaches for mental disorders such as depression and PTSD in primary care settings. • Collaboration with the Department of Defense to aid troops returning from Iraq with recovery and rehabilitation based on the concept that mental health is a part of overall health care. • Models and educational programs that focus on vocational rehabilitation, with $6 million for new Supported Employment Mentor training sites and $10 million for Compensated Work Therapy support. • A model national plan for family care and a consumer liaison directive. VHA’s 21 administrative districts, called Veterans Integrated Service Networks (VISNs), are charged to participate in their States’ mental health plans. • Education and research on cultural competence. For example, a series of videotape programs on PTSD in Native American, Asian American/ Pacific Islander, African American, and Hispanic American veterans has been made for clinicians and for

patients and families. VA will also collaborate with Federal Partners to identify best practices for improving rural health care for veterans. • Annual screening for depression, PTSD, and substance abuse. Selfadministered screening instruments are under development. • Testing of recovery-oriented research across the life cycle for generalizability across the VA system. • Piloting of peer specialist supports. • Rolling out evidence-based practices, such as collaborative care for depression, across the VA system. • Implementing a Tele-Mental Health (TMH) initiative through the VISNs and the Office of Care Coordination; expanding TMH to improve in-home access and services for homeless veterans; developing a mental health treatment planning tool and a mental health component for the Internet-based MyHealtheVet system. To obtain additional information on VA transformation activities, contact Dr. Frances Murphy at 202-565-6363 or Dr. Larry Lehmann at 202-273-6900. THE FEDERAL PARTNERS
SAMHSA/CMHS greatly appreciates the collaboration, leadership, and support of all our Federal Partners in helping to create and implement transformed mental health care for all Americans. • Department of Agriculture • Department of Education • Department of Health and Human Services • Department of Housing and Urban Development • Department of Justice • Department of Labor • Social Security Administration • Department of Transportation • Department of Veterans Affairs


SAMHSA/CMHS Identifies Key Priorities
AMHSA is identifying key priorities within the Center for Mental Health Services (CMHS) to better support the framework of recoveryoriented systems. Thinking strategically and working collaboratively, CMHS is looking at “what is” and asking “what should be” to promote innovative approaches and effective performance in addressing the mental health needs identified by consumers and families. These are the eight crucial areas that have become priorities for consideration as the Nation moves forward with efforts to transform the mental health system: • Leadership Develop a versatile program for grooming transformational leaders at State and local levels as a critical


component for creating a mental health care system built around consumers’ needs. Comprehensive State Planning Develop a model Comprehensive State Mental Health Plan. Individualized Care Plans Identify and disseminate a prototype individualized care plan that fosters resilience and recovery. Disparities Initiate a series of activities driven by the development of a national strategic plan for the elimination of disparities in mental health services. National Registry of EvidenceBased Programs and Practices Continue a strong science-toservice agenda for achieving the widespread availability of evidencebased treatments in supporting

recovery for individuals with mental illnesses. • Workforce Development Develop a national strategic plan for training an expanded, diverse, competency-based workforce. • Technology Use Health Technology to improve access and coordination of mental health care. • Finance Implement efficient public and private reimbursement strategies. These priorities are pivotal components for coordinating program planning and management strategies within CMHS. As anchors for the development of the Center’s grant and contract portfolio, these priorities will help ensure capacities for delivering quality services and products in the future.

State Teams to Get Help on Mental Health Transformation
AMHSA’s Center for Mental Health Services (CMHS) is working with the National Governors Association (NGA) Center for Best Practices to host four regional meetings on Transforming State Mental Health Systems. These meetings will help States understand how mental health issues affect policy priorities across agencies and services, assess their own mental health systems, and develop a vision and plan for transformation. Each State Governor’s office can send a four-person State team to one regional meeting at SAMHSA’s expense; additional team members may participate at the State’s expense. The first regional meeting will be held June 13-14, 2005, in Chicago. Subsequent meetings are planned for September 22-23, 2005, in Los Angeles; March 2006 in New Orleans; and June 2006 in Boston. Over the past 18 months, the NGA Center has partnered with CMHS to raise awareness of mental health transformation needs and strategies among the Offices of the Governors


by (a) distributing the New Freedom Commission Report to all States; (b) producing and distributing a reference guide to key concepts in the Report; (c) placing notices on the NGA Center

Web site ( and in its newsletter; (d) answering questions regarding the Report; and (e) hosting a Web conference focused on mental health transformation.

Resource Corner
Identified here are printed materials and Web sites that may be helpful in promoting mental health systems transformation. Listing here is not intended to imply endorsement by any agency of the U.S. Government. SAMHSA National Mental Health Information Center For all funding announcements, see www. or Health Care Financing Review. (Fall 2004). Mental Health. Centers for Medicare and Medicaid Services, Office of Research, Development, and Information. Sixteen State Study on Mental Health Performance Measures Sharing the Hope, Sharing the Healing of Mental Illness Recovery Council of State Governments Mental Health Tool Kit—Fostering Recovery through State Action